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People with Crohn’s disease usually alternate between periods when the disease is quiet and periods that involve flare-ups. But by identifying the trigger of these flares, you can minimize your symptoms in the future.

Crohn’s Symptoms: Common Triggers

Crohn’s symptoms can reawaken for unknown reasons, but by being alert and aware, you may be able to identify the specific triggers that have an effect on you:

Stress: The connection is poorly understood, but stress is thought to lead to flares in some people living with Crohn’s, says R. Balfour Sartor, MD, who directs the Broad Medical Research Program of the Crohn's & Colitis Foundation of America (CCFA) and is a professor of medicine, microbiology, and immunology at the University of North Carolina-Chapel Hill.

In people who don’t have Crohn’s, “stress increases blood flow to the gut, which increases motility and stimulates contractions in the intestines, leading to diarrhea and nausea,” Dr. Sartor says. For people living with Crohn’s disease, who are already susceptible to cramping and diarrhea, it can be even worse, since stress can exacerbate these symptoms. “Beyond that, there is some evidence that stress can stimulate inflammation and activate disease activity,” he adds.

Smoking: Cigarettes can not only trigger flares, they can also raise the risk for more frequent surgery to treat Crohn’s, according to a review of data from 33 studies. The risk for more severe Crohn’s disease appears to go down after a smoker quits, according to researchers writing in the March 2016 issue of AlimentaryPharmacology & Therapeutics.

“One theory is that smoking causes constriction of blood vessels and leads to inadequate oxygen flow and nutrition in the intestines and increases biochemical mediators of inflammation, which causes injury to the area,” Sartor says.

Medications: Aspirin, ibuprofen, and certain antibiotics are some of the medications that can trigger flares in people with Crohn’s disease. Antibiotics change the balance of bacteria in the intestine, which can activate diarrhea even in people who do not have Crohn’s, Sartor notes.

Diet: Certain foods can change the bacterial profiles in people’s guts, triggering symptoms in some people with Crohn’s. No one type of food will cause flare-ups in everyone, so people should track their diets to determine the culprits. In general, foods that can increase gas and diarrhea — such as greasy and fried foods, beans, cabbage, and carbonated drinks — should be avoided. It’s also a good idea to stay away from raw vegetables, watermelon seeds, peanuts, or popcorn, especially if you are among those with Crohn's disease who have a narrowing of the intestines, which increases the risk for intestinal obstruction, Sartor says.

Infections: Infections can also precipitate flare-ups, according to Sartor. “We know that gut infections can kick off symptoms in patients whose symptoms had been quiescent," he says. There's also some evidence that bacterial and viral infections can set off Crohn’s in people who have never had any symptoms. For example, he says, people may go on vacation and contract an infection — think “Montezuma’s revenge” — after exposure to E. coli. Though other travelers may get better without any residual problem, someone who's genetically susceptible to Crohn’s may lack a mechanism to turn off the inflammation, Sartor explains.

Seasonal changes: Some people have flare-ups at different times of the year. “One theory is that it might have something to do with allergy to pollen or exposure to respiratory infections,” Sartor says.

Crohn’s Symptoms: Identifying Your Triggers

Before you can avoid triggers, you must identify them. Because triggers can vary from person to person, the best strategy is to keep track of the circumstances surrounding your flare-ups. Ask yourself the questions a doctor would ask to try to pinpoint triggers, such as:

Are you taking ibuprofen, aspirin, or a similar medication?

Did you have recent antibiotic exposure?

Did you recently have an infection?

Have you traveled recently?

Do you smoke?

In the week before your flare-up, did you experience stress or anything that was unusual?

Another useful way to identify triggers is to keep a journal of what you eat. That way, you will know everything you had within 24 hours of experiencing symptoms. It’s probably not necessary to write down every bite, Sartor says, but getting into the habit of listing the foods and beverages you consume each day, particularly ones commonly associated with triggering Crohn’s symptoms, makes sense. By keeping track of your daily routine as well, you can be your own detective and uncover any common threads between your flare-ups.

Crohn’s Symptoms: Avoiding Triggers and Calming Their Effects

Once you’ve identified your Crohn’s triggers, the next step is to avoid them:

If you suspect stress is one of your triggers, do what you can to eliminate or at least reduce your stress levels. “If you’re in an occupation that’s continuously stressful, look for another job,” Sartor says. “If you’re experiencing marital stress, go for counseling.” Try yoga, meditation, breathing exercises, listening to music — whatever works to help you relax. You may need to talk with your doctor about medications that can help lower your stress levels.

If you smoke, find a way to stop.

Stay away from aspirin and ibuprofen and switch to acetaminophen, which does not trigger flare-ups in people living with Crohn’s.

Avoid foods that are more likely to cause gas or increase the risk for intestinal obstruction.

By identifying and then avoiding all possible triggers, you can reduce the number of Crohn’s flare-ups you experience.

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